Narrowing the Gap Between Insight and Change: Yoga, Psychotherapy, and the Body
a conversation with Bo Forbes
What is the role of the body in psychotherapy, a field in which the mind and the emotions have traditionally been emphasized? To explore this question, Kripalu Online editor Grace Welker talks with Bo Forbes, a clinical psychologist who has been successfully introducing yoga into the therapeutic setting to treat a wide range of chronic issues, including anxiety, insomnia, depression, ADD, and fibromyalgia.
Kripalu Online In 2006, you gave a talk on yoga, meditation, and psychotherapy to more than 700 psychotherapists from throughout the country at a conference at Harvard University, and while you were giving the talk you had people actually practicing restorative yoga postures on a stage behind you—postures used to treat anxiety on one side and postures used for depression on the other. What a creative approach to your topic.
Bo Forbes I really wanted to give people a felt sense of restorative yoga beyond a diagram showing the shapes of the poses. In restorative yoga practice, after about half an hour, there’s a “ripening point,” a deep letting go when things suddenly deepen and that external layer of stuff that we live with all the time, including our worries and anxieties, drops away. We’re left with something that’s much richer, more resonant. So rather than just talk about what happens, I wanted the people at the conference to see it and feel it in action.
KOL What was it that got you started on this path of combining psychotherapy and yoga?
Bo Forbes I’d been practicing psychotherapy for a number of years. While I found it effective enough—it really helps support some people to function well and gain insight into patterns—I’d also started thinking, “Boy, this takes a long time.” And it seemed, inherently, to instill dependency on the psychotherapist.
KOL Right. The therapist has to be physically present. People can’t do therapy for themselves.
Bo Forbes Exactly. At the same time, I was recognizing that therapy addresses the mind and the emotions but leaves out the physical body altogether— and, in most cases, it bypasses the soul or spirit. In classical psychotherapy, intuition, for example, is considered countertransference, or the therapist’s own “stuff.” But I began to explore the use of intuition and the incorporation of the soul into psychotherapy, which clients really appreciated and responded to. I also began to investigate other methods of healing, which inaugurated a personal journey that eventually led me to yoga. And the yoga bug really bit me.
KOL I know exactly what you mean. How was it for you?
Bo Forbes Mainly, it spoke to all levels of someone’s being. But it didn’t occur to me that yoga and psychotherapy could be combined professionally. I thought I had to choose one or the other. Eventually, I reduced my private practice and committed to the study of yoga, not knowing where it would lead.
KOL So what happened next?
Bo Forbes A few clients wound up changing the course of things. These were holistically minded people who took yoga classes but who had high levels of anxiety, to the point where their physicians recommended medication. So they came to me and asked if I would work with them individually, using yoga, to see if they could avoid the medication.
I said “yes,” and in private sessions, we worked at first on postures and alignment and slow Sun Salutations, and then we would end each session in a restorative posture. And after a couple of restorative poses, their breathing would slow down, and there was a palpable feeling of relaxation. Over time, the effects were so dramatically positive that we began to increase the time spent in the restorative poses. And the clients reported feeling better—less anxiety, better quality of sleep—experiencing improvements in primary relationships, and other benefits.
KOL One of the strengths that you seem to bring to this inquiry into the therapeutic applications of yoga is that, because of your scientific background, you don’t jump to conclusions based on a couple of anecdotal situations.
Bo Forbes Oh no. I just thought, “This is interesting, but it’s probably particular to these clients.” But my interest was piqued, and I began to look more closely at what was happening. Next I noticed something else: when people would arrive for their session and give me an update on how their week had gone, that update was very left-brain oriented, very attached to whatever their “story” was, something like, “Well my boyfriend did this, and I did that, and he’s such a jerk, and he always does this.”
KOL Like people do in therapy or with friends.
Bo Forbes Exactly. You know, the stories we all tell and become so attached to. And then I would say, “Okay, let’s do a little yoga,” and we would get into restorative poses and do a little breathing, and maybe 10 minutes later I would say, “So tell me a little more about that fight with your boyfriend,” and the amazing thing was that the processing completely changed.
Bo Forbes It came with a more global understanding, a “spiritual” context and framework. For example, one woman who was caught in a cycle with her boyfriend would talk in the initial part of the session about how withholding and unresponsive her boyfriend was. But after 10 or 15 minutes of restorative poses and breathwork, we’d circle back to the topic, and she could see, for example, that the pressure she put on him felt confining, very much like what he’d experienced growing up as a child. So his retreat was not aimed toward rejecting her but for self-preservation. She could put herself in his shoes. And I noticed that this kind of deepened processing was not particular to one or two individuals; it happened much of the time.
KOL How did this help?
Bo Forbes Well, it seemed to initiate a lot of positive growth and lasting change in very entrenched patterns. For example, one of those original clients, who’d had quite severe anxiety, had gotten better really fast—without medication. She was a health-care professional, and one day she said to me, “I’d like to refer someone from our practice to you for this yoga therapy stuff you’re doing,” and I looked at her and said, “Yoga therapy?” And that’s when it hit me.
KOL That was the moment when you saw you could combine your twin passions?
Bo Forbes That was my “aha” moment. So I kept up that “yoga therapy stuff,” and those initial results continued to replicate themselves with virtually everyone I saw. And this is important not just in psychotherapy circles. I think more and more yoga classes are seeing large numbers of people come in with anxiety and depression, ADD, anger-management issues, and other emotional issues because their doctors and therapists are saying, “You need to do some yoga.”
KOL So people are popping in to class and bringing their stuff to the mat, and their teachers aren’t necessarily prepared to handle it. Now you are training people to become yoga teachers who can work with clients therapeutically?
Bo Forbes Yes. I offer the first official mind-body yoga teacher training program in the country to be recognized by Yoga Alliance. There’s a 10-month, 200-hour training as well as a 500-hour training and an advanced apprenticeship track. In all three, students work with actual clients—people with anxiety, insomnia, depression, fibromyalgia, chronic fatigue, arthritis, and other ailments.
KOL I also think it’s very exciting that your 200-hour training offers continuing education credits for social workers and for psychologists. That’s trendsetting: a yoga program being recognized as a viable professional training for therapists!
Bo Forbes We’ve had a number of psychotherapists go through our teacher training, and it completely changes the way they practice. There are several more in the training this year. You know, when we read the evaluations from the Harvard conference, a lot of the participants basically said, “Talk therapy’s not working so well. We want to bring what is now understood about the mind-body connection to what we are doing.”
KOL What is it that is not working in talk therapy?
Bo Forbes Well, what does work is people identifying and understanding their problems and even figuring out what they need to do. But then there’s this gap between the understanding and the actual doing: the shifting of these long-held patterns of thought, emotion, and behavior—what in yogic terms we call “samskaras.” Clients say, “I know what the problem is” or “I know what I need to do, but I just can’t get there.” And psychotherapy has only recently begun to consider the body side of the mind-body connection, thanks in large part to the introduction of mindfulness practices into psychotherapy, which have been instrumental in paving the way for yoga to enter the dialogue. So the gap that occurs in psychotherapy between insight and change can be narrowed by incorporating the body and the spirit through yoga.
KOL This makes me think of the recent discoveries in the neurosciences and other fields that prove that we hold memories and emotions and experiences in the tissues of our body.
Bo Forbes Absolutely. And these memories, emotions, and experiences are written onto our nervous systems and even encoded into our movement patterns. So everything in yoga is an opportunity to release what’s being held, to change those patterns that are no longer healthy, and exchange them for healthier ones, which is, of course, the point of therapy.
Bo Forbes, PsyD, is a leading clinical psychologist, yoga teacher, and yoga therapist in the Boston area. She is director of the Elemental Yoga Mind-Body Teacher Training Program and the Center for Integrative Yoga Therapeutics in Cambridge, Massachusetts. www.elementalyoga.com
© Kripalu Center for Yoga & Health. All rights reserved. Originally published in the October 2007 issue of Kripalu Online. To request permission to reprint, please e-mail firstname.lastname@example.org.